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Feds Issue ICD-10, HIPAA 5010 Rules


August 18, 2008

The Centers for Medicare and Medicaid Services on August 15 announced a proposed rule to adopt the ICD-10 code sets for diagnoses and procedures, effective Oct. 1, 2011.

CMS also announced a separate proposed rule to migrate to Version 5010 of the HIPAA transaction sets, and Version D.0 of the National Council for Prescription Drug Programs’ standards. Under the proposal, compliance with the transaction sets would be required by April 1, 2010. The proposed rule also includes a standard for a Medicaid pharmacy subrogation transaction. Subrogation is the process by which state Medicaid agencies recoup payments when a Medicaid recipient has coverage from another payer that has primary responsibility. Compliance with this standard would be required two years after the effective date of the final rule, except for small health plans, which would have an additional year.

The ICD-10 and transactions rules have long been expected and must move together, as Version 5010 was designed to be used with the ICD-10 code sets. The ICD-9 code sets, developed nearly 30 years ago, contain 17,000 codes and can no longer be adequately expanded. The ICD-10 code sets have more than 155,000 codes to accommodate advances in diagnoses and procedures. The new codes also will facilitate more granular data collection and reporting, such as specifically identifying such conditions as Methicillin-Resistant Staphylococcus aureus, according to federal officials.

The proposed rules soon will be published in the Federal Register. Public comments are due on Oct. 21. To view both regulations, click here.

CMS soon will post fact sheets describing both proposed rules, at cms.hhs.gov/apps/media/fact_sheets.asp.

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